| NPI | 1649559147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: MN 58771) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: MI 4301098699) |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2020-08-04 |